A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion,shortness of breath,chronic cough,and wheezing.On physical examination,patient shows barrel-shaped chest,prolonged exhalation,circumoral cyanosis,and wheezing throughout both lung fields.Heart has regular rate and rhythm of 80 beats/min.Abdomen is obese and non-tender.Extremities show no significant findings.No neurological deficits.Arterial blood gases reveal acidosis.These signs and symptoms are characteristic of:

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The patient's symptoms of fatigue with exertion, shortness of breath, chronic cough, and wheezing, as well as physical exam findings of barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields are all characteristic of chronic obstructive pulmonary disease (COPD), which is commonly associated with a history of smoking. The arterial blood gas finding of acidosis also supports the diagnosis of COPD. Neither congestive heart failure nor asthma typically present with a barrel-shaped chest or prolonged exhalation, and heart failure is usually associated with edema and signs of fluid overload. Lung cancer may present with similar symptoms, but the presence of wheezing throughout both lung fields is suggestive of a more diffuse airway obstruction such as COPD.

A 67-Year-Old Male with a Smoking History of 120-Pack Years